Chlorambucil

Chlorambucil is used in the treatment of some cancers of blood and lymphatic system. It may be also used to treat other kinds of cancer, as determined by the doctor. It is used alone or in combination with other cancer medicines. Chlorambucil should be taken empty stomach, or 1 hour before and 2 hours after a meal. But, try to have it at the same time every day for most benefits. This will depend on what you are being treated for and may change from time to time. You should take it exactly as your doctor has advised. Taking it in the wrong way or taking too much can cause very serious side effects. It may take several weeks or months for you to see or feel the benefits but do not stop taking it unless your doctor tells you to. The most common side effects of this medicine include anemia (low number of red blood cells), decreased blood cells (red cells, white cells, and platelets) decreased white blood cell count, infection, nausea and vomiting. If these bother you or appear serious, let your doctor know. There may be ways of reducing or preventing them. Inform your doctor if you have a medical history, of bleeding disorders, heart or liver disease, radiation treatment or any infection. Many other medicines can affect, or be affected by, this medicine so let your doctor know all medications you are using. This medicine is known to reduce the number of blood cells in your blood thereby, increasing the susceptibility to infections. Regular blood tests are required to check your blood cells along with kidney, liver and heart function during treatment with this medicine. The use of effective contraception by both males and females during treatment is important to avoid pregnancy. Chlorambucil is an anti-cancer medication. It works by damaging the genetic material (DNA and RNA) of the cancer cells. This stops their growth and multiplication.

• Blood cancer • Hodgkin’s disease

Chlorambucil interferes with DNA replication and RNA transcription by alkylation and cross-linking cellular DNA strands, thus leading to disruption of the nucleic acid function.

Adult Dose: Chronic Lymphatic (Lymphocytic) Leukemia 0.1 mg/kg/day for 3-6 weeks or 0.4 mg/kg (increased by 0.1 mg/kg/dose until response/toxicity observed) biweekly or 0.4 mg/kg (increased by 0.1 mg/kg/dose until response observed) monthly or 0.03-0.1 mg/kg/day continuously Reduce initial dose if administered within 4 weeks after a full course of radiation/myelosuppressive therapy or patients with bone marrow disease Not to exceed 0.1 mg/kg/day if bone marrow infiltrated with lymphocytes Hodgkin's Lymphoma 0.2 mg/kg/day for 3-6 weeks or 0.4 mg/kg (increased by 0.1 mg/kg/dose until response/toxicity observed) biweekly or 0.4 mg/kg (increased by 0.1 mg/kg/dose until response or toxicity observed) monthly or 0.03-0.1 mg/kg/day continuously Reduce initial dose if administered within 4 weeks after a full course of radiation/myelosuppressive therapy or patients with bone marrow disease Not to exceed 0.1 mg/kg/day if bone marrow infiltrated with lymphocytes Hepatic Impairment Primarily metabolized in liver; dose reduction may be required Renal Dose: Renal Impairment <1% (including metabolites) excreted in urine; no dose adjustment required

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Chlorambucil is to be taken empty stomach.

If you miss a dose of Chlorambucil, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.

Common: • Anemia (low number of red blood cells) • Decreased blood cells (red cells, white cells, and platelets) • Decreased white blood cell count (neutrophils) • Decreased white blood cell count • Bone marrow suppression • Nausea • Vomiting • Diarrhea • Mouth ulcer

[CONSULT YOUR DOCTOR] It is not known whether Chlorambucil alters the ability to drive. Do not drive if you experience any symptoms that affect your ability to concentrate and react. Chlorambucil should be taken one hour before a meal or two hours after a meal.

Hypersensitivity. Pregnancy and lactation. Porphyria.

Impairs immune response to vaccines, possible infection after admin of live vaccines.

[CONSULT YOUR DOCTOR] It is not known whether it is safe to consume alcohol with Chlorambucil. Please consult your doctor.

[CONSULT YOUR DOCTOR] Chlorambucil may be unsafe to use during pregnancy. Although there are limited studies in humans, animal studies have shown harmful effects on the developing baby. Your doctor will weigh the benefits and any potential risks before prescribing it to you. Please consult your doctor.

[UNSAFE] Chlorambucil is unsafe to use during breastfeeding. Data suggests that the drug may cause toxicity to the baby.

[CAUTION] Chlorambucil should be used with caution in patients with kidney disease. Dose adjustment of Chlorambucil may be needed. Please consult your doctor. Careful monitoring by a doctor is important as kidney disease patients are at an increased risk of bone marrow depression and inflammation and infections of urinary bladder while taking this medicine. [CONSULT YOUR DOCTOR] There is limited information available on the use of Chlorambucil in patients with liver disease. Please consult your doctor.

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